Community ownership the way to go

Cathrine Murombedzi HIV Issues
THE recent new anti-retroviral guidelines which state that one commences ARVs on testing HIV positive will see an influx of new clients on the waiting list. Why do I call them clients ­­-I say so because with a CD4 count of 1 000 one is not ill hence calling that person a patient may be misleading.

The World Health Organisation reported that with a CD4 count of 500 a total 1,4 million people were HIV positive in Zimbabwe. Test and treat will be the new way and if funded adequately could curb new HIV infections. With those on medication and adhering to set out guidelines on taking medicine, the probability of such a person passing on the virus become minimal. In fact, with correct use of protection and Zimbabwe having “used” over 25 million condoms in 2013, we should be recording near zero HIV infections.

Any condoms, female or male, that are taken from centres are deemed to have been used correctly but that is not always the case. Some find their way in floor polish making and some of the condoms are cut up with the rich oil taken up as hair food. So the 25 million condoms taken in 2013 can’t be a true reflection of condom uptake and usage.

There is one province that has shone like a beacon in managing HIV infections, counselling and treatment and people living with the virus in the area have broken down stigma barriers as they work as volunteers in most of the programmes and in awareness campaigns. The community as a whole participates when there is need to upgrade a clinic, a road or build houses for staff.

Mashonaland Central has eight districts, namely Bindura, Mazoe, Guruve, Muzarabani, Mbire, Shamva, Mt Darwin and Rushinga with a population of one million. Of these, 93 000 are living with the HIV virus, 52 000 are on active anti-retroviral therapy (ART) and 41 000 are not. The 41 000 are to commence ART when they require it. This means that their CD4 count was above 350 as of August 2013. With the new WHO guidelines which state that any HIV positive person has to commence ART at a CD4 count of 500, about 18 000 would have to be accommodated on the ARVs free government programme.

The province has 141 ART initiating sites. Three districts – Bindura, Mazowe and Shamva – have moved onto computerisation of patients’ data. The province has decentralised ART access as seen by the number of sites initiating ART. Some of the sites now order directly from Natpharm thereby removing bottlenecks and artificial shortages.

There is programme ownership with people living with HIV (PLHIV) volunteering to work as peer counsellors and village health workers at some of the ART sites.

With the community participating it makes client-follow up much easier. The province was cited as a best practice by the National Aids Council. A report from the community monitoring group which visited the area in the second quarter of 2013 reported a marked increase of community participation as compared to other provinces nationally.

The Provincial Medical Director, Dr Solomon Mukungunugwa, said community ownership of anything that is health-related by the people in the province made work easier for health personnel.

“In my province, for example in Chiweshe , Mazowe District at Rosa Clinic 12 houses for staff members at the clinic were built with input from the village committee. Their local Member of Parliament provided cement, the villagers made bricks, those who afforded contributed a dollar to the project and some even brought grain which all helped to see the smooth building of the houses and an opportunistic infections (OI) wing,” said Dr Mukungunugwa.

“The villagers give grain to all health facilities that have admission facilities. A total of 38 tonnes were collected in Chiweshe for use by hospitals which is very commendable,” he added.

Dr Mukungunugwa said that with the provision of good houses staff turnover was limited as seen at Rosa Clinic.

“Rosa Clinic offers OI services five days a week. It started offering ART services in 2010 thereby easing congestion at Howard Mission Hospital. Many clients now opt to be served from centres near their homes.

 Feedback:[email protected].